Submission of application for engagement of Health Care Providers (HCPs). 26. 7. Filing of claims. 32. 8. ..... hospital
PhilHealth Citizen’s Charter (PCC) 2013 (modified as of November 2013) Table of Contents Title
Page
A.
Vision
3
B.
Mission
3
C.
Values
3
D.
Panunumpa sa Serbisyo
3
E.
Frontline Services Offered and Clientele
F.
4-37
1.
Registration
2.
Enrollment (IPM/Overseas Workers)
10
3.
Payment of premium contributions
14
4.
Inquiry
17
5.
Updating of records
17
6.
Submission of application for engagement of Health Care Providers (HCPs)
26
7.
Filing of claims
32
8.
Submission of reports (manual)
36
9.
Request for records
37
10.
Check releasing
37
Matrix of Service Standards (for frontline services)
4
38-53
1. Membership registration (Employer/Employee/Lifetime Member)
38
2. Membership enrollment (All Member Types)
41
3. Updating of membership records
43
4. Request for records (MDR/Certificates/PIC/CE1)
44 1|P age
Title
Page
5. Payment of premium contributions
45
6. Inquiry/public assistance
46
7. Filing of claims by IHCPs
46
8. Filing of claims (Direct-filing by members)
47
9. Submission of remittance reports (RF1)
48
10. Submission of application for accreditation by Health Care Institutions
48
11. Submission of application for engagement of Health Care Professionals
49
12. Check releasing (pick-up by member)
51
13. Check releasing (pick-up by stakeholders)
51
14. Request for other services
52
15. Feedback mechanism
53
G.
Process Flow Chart
54
H.
Feedback and Redress Mechanism
I.
Anti-fixer Campaign Banner
57
J.
Anti-fixer Campaign Calling Card
58
55-56
Table 1. Premium Contribution Table for the Formal Economy including sea-based employees and Kasambahay
Annex A
Table 2. Premium Contribution Table for the Informal Economy /Sponsored Members
Annex B
Table 3. Premium Contribution Table for Migrant Workers
Annex B
Table 4. Schedule of Accreditation Fee for Health Care Institutions
Annex C
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A.
Vision
Bawa’t Pilipino Miyembro, Bawat Miyembro, Protektado, Kalusugan Natin, Segurado
B.
Mission
Sulit na Benepisyo sa Bawat Miyembro, Dekalidad na Serbisyo para sa Lahat
D.
Values I-nnovation Q-uality Service U-tmost Integrity E-quity S-ocial Solidarity & T-otal Care
C.
Panunumpa sa Serbisyo
Kami ay nangangakong ilalaan ang mga sarili sa pagsasakatuparan ng Kalusugang Pangkalahatan. Sisikapin naming makapagbigay nang mabilis at de kalidad na serbisyong pangkalusugan sa lahat ng Pilipino, ano man ang edad, kasarian o estado ng pamumuhay. Kaagapay namin ang mga miyembro sa pagtataguyod ng panlipunang pagkakaisa bilang isang konseptong mahalaga sa pagkamit ng aming layunin. Patuloy naming paghuhusayin ang aming mga serbisyo at titiyaking ang mga ito’y umaayon sa nagbabagong panahon at sumasabay sa pandaigdigang pamantayan. Titiyakin naming laging mauuna ang serbisyo-publiko at taas noo na maglilingkod sa bayan. Sisikapin naming maging huwarang kawani at makamit ang tunay na pagbabago sa ating bansa.
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E. Frontline Services Offered and Clientele 1. Registration (Formal Economy, Employee, Lifetime) Frontline Services &
•
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele 1.1 Formal Economy 1.1.1 Government
NONE
• No service fee
• 10 minutes
• No service fee
Within the day
• No service fee
• 15 minutes
Record(ER1) Form
sector
1.1.2 Private Sector
• Employer Data
A. For employers enrolling thru the Philippine Business Registry (PBR) • NONE B. Non-PBR • Business permit/license to operate and/or any of the following: a) Department of Trade and Industry (DTI) Registration (for single proprietorship) b) Securities and Exchange Commission (SEC) Registration (for partnerships, corporations, foundations, & non-profit organizations) c) Cooperative Development Authority (CDA) Registration (for cooperatives) d) Barangay Certification and/or Mayor’s Permit (for backyard industries/ventures and micro-business enterprises)
• PBR Form
• ER1 Form
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Frontline Services &
•
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele 1.1.3 Employer Government and Private) User of Electronic Premium Reporting System (EPRS) registration
Manual Submission • None
Electronic Submission • None
1.2 Employee 1.2.1 For newly hired and existing employees without PIN yet
• None
• PhilHealth Online Access Form (POAF)
• No service fee
• 5 working days (registration)
• Electronic PhilHealth Online Access Form (e-POAF)
• No service fee
• 5 working days (registration)
• PMRF • ER2
• No service fee
• 20 minutes (for 5 PMRFs and below) • 10 working days (for 6 PMRFs and Above)
1.3 Lifetime Membership Program
•
2 latest 1x1 ID photo
•
Specimen signature
• PMRF
• No service fee
• 20 minutes
General requirements for all categories of retirees
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Frontline Services &
•
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele Specific requirements per category 1.3.1 SSS retirees/ pensioners
1.3.2 GSIS retirees
• Printout of Death, Disability and Retirement (DDR) from any SSS office indicating that the type of claim is retirement in nature and the effectivity date of pension; or • Printout of contributions issued by SSS office indicating the latest contributions (if they retired after March 4,1995)
• PMRF
• No service fee
• 20 minutes
•
• PMRF
• No service fee
• 20 minutes
• No service fee
• 20 minutes
Any of the following: Certification/Letter of Approval of Retirement from GSIS Service Record issued by employer/s indicating date of retirement and total number of service not less than 120 months Certification/Retirement Gratuity from employer indicating not less than 120 months of service.
1.3.3 AFP, PNP and BFP Retirees/ Pensioners • Any of the following: • PMRF (those who are inactive Statement of Services from previous employer military service until indicating not less than 120 months of service they retire at age 56 and Certification/Letter of Approval of Retirement from those separated by GSIS not less than 120 months of service retirement or other reasons prior to the said General, Bureau or Special Order indicating effectivity of retirement. age but have reached the age of 60)
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Frontline Services &
•
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele 1.3.4 Retiring employees whose application for the Lifetime Member Program (LMP) will be facilitated by the employer three (3) months prior to the date of retirement
• Photocopy of the following documents, duly certified
• PMRF
• No service fee
• 3 minutes
by the employer: Approved retirement application and proof of contributions or Service Record
1.4 Members Declaration None of Dependents If warranted - Case to Case basis but not limited to the following:
• PMRF
• No service fee
(Part of registration under 1.2)
a) Spouse • Marriage Certificate/Contract with registry number • For marriage which took place abroad, marriage certificate stamped “Received” by the Philippine Embassy or consular office exercising jurisdiction over the place of marriage b) Muslim Spouse • Affidavit of Marriage issued by the Office of Muslim Affairs (OMA), which passed through the Shari’a Courtand must be registered/authenticated in the National Statistics Office (NSO)
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Frontline Services &
•
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele c) Legitimate or illegitimate children below 21 years old • Birth Certificate with registry number or Baptismal Certificate reflecting the name of the member as parent • For births which took place abroad, Birth Certificate Stamped “received” by the Philippine embassy or Consular office exercising jurisdiction over the place of birth d) Adopted children below 21 years old • Court Decree/Resolution of Adoption or Birth Certificate of the adopted child/ren in which adoption is annotated thereto e) Stepchildren below 21 years old • Marriage Certificate (with registry number) between biological parents and step father/stepmother and Birth Certificate/s (with registry number) of the stepchildren f) Mentally or physically disabled children who are 21 years old and above • Birth Certificate and original Medical Certificate issued by the attending physician within the past 6 months stating and describing the extent of disability
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Frontline Services &
•
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele g) Parent/s 60 years old and above • Birth Certificate with registry number of both registrant and parent (in the absence of Birth Certificate of parent, any proof attesting to the date of birth of parent/s) h) Step parents 60 years old and above • Marriage Certificate/Contract with registry number between biological parent of the member-child and the stepparent; • Birth Certificate of the stepparent (in its absence, a notarized affidavit of 2 disinterested persons attesting to the date of birth); • Birth Certificate of the member-child indicating the name of his/her biological parent; and • Death Certificate of member’s deceased biological parent i) Adoptive parents 60 years old and above • Court Decree/Resolution of Adoption or photocopy of Birth Certificate o f the child in which the adoption is annotated thereto; and • Birth Certificate/s of adoptive parents or in its absence, a notarized affidavit of 2 disinterested persons attesting to the date of birth j) Foster Child • Foster Placement Authority from DSWD
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Frontline Services &
•
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele Parents with permanent disability totally dependent with member • Original Medical Certificate issued by the attending physician within the past 6 months stating and describing the extent of disability
2. Enrollment Frontline Services & Clientele
Documentary Requirements
PhilHealth Forms
Fees/s
Duration
2.1 Informal Economy 2.1.1 Informal Sector (formerly known a s Individually Paying Member) 2.1.2 i-Group (Organized Group)
• None
• PMRF
• No service fee
• 5 minutes
• Signed MOA
• PMRF
• No service fee
• 10 minutes
• Applicable Certification from BSP, COA, SEC, DTI &
• IPAF
LGU
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Frontline Services & Clientele 2.1.3 Migrant Workers (landbased)
2.1.4 Foreign Nationals
Documentary Requirements • None
PhilHealth Forms
Fees/s
Duration
• PMRF
• No service fee
• 5 minutes
• PMRF
• No service fee
• 5 minutes
If warranted: • Any of the following as proof of being an active OFW: Valid Overseas Employment Certificate (OEC) or Ereceipt of current year or is valid for one (1) year from date of transaction; or Working Visa/Re-entry Permit; or Valid Job Employment Contract; or Certificate of Employment for applicable period from Employer abroad; or Valid Company ID issued by Employer abroad; or Cash Remittance receipt from member abroad at least 2 months prior to the date of renewal/payment; or Valid workers' Identification (ID) Card issued bythe host country (i.e.Hongkong ID,Iqama of Saudi, Permessod' Soggiorno and Cartad'Identita of Italy);or Any other equivalent document that will prove that the member is an active OFW. Valid workers' Identification (ID) Card issued by the host country (i.e.Hongkong ID,Iqama of Saudi, Permessod' Soggiorno and Cartad'Identita of Italy);or Any other equivalent document that will prove that the member is an active OFW. • Alien Certificate Registration (ACR)
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Frontline Services & Clientele 2.2 Members Declaration of Dependents
Documentary Requirements
None If warranted - Case to Case basis but not limited to the following:
PhilHealth Forms
• PMRF
Fees/s
• No service fee
Duration
(Part of registration under 2.1)
a) Spouse • Marriage Certificate/Contract with registry number • For marriage which took place abroad, marriage certificate stamped “Received” by the Philippine Embassy or consular office exercising jurisdiction over the place of marriage b) Muslim Spouse • Affidavit of Marriage issued by the Office of Muslim Affairs (OMA), which passed through the Shari’a Courtand must be registered/authenticated in the National Statistics Office (NSO) c) Legitimate or illegitimate children below 21 years old • Birth Certificate with registry number or Baptismal Certificate reflecting the name of the member as parent • For births which took place abroad, Birth Certificate Stamped “received” by the Philippine embassy or Consular office exercising jurisdiction over the place of birth d) Adopted children below 21 years old • Court Decree/Resolution of Adoption or Birth Certificate of the adopted child/ren in which adoption is annotated thereto 12 | P a g e
Frontline Services & Clientele
Documentary Requirements
PhilHealth Forms
Fees/s
Duration
e) Stepchildren below 21 years old • Marriage Certificate (with registry number) between biological parents and stepfather/stepmother and Birth Certificate/s (with registry number) of the stepchildren
f) Mentally or physically disabled children who are 21 years old and above • Birth Certificate and original Medical Certificate issued by the attending physician within the past 6 Months stating and describing the extent of disability g) Parent/s 60 years old and above • Birth Certificate with registry number of both registrant and parent (in the absence of Birth Certificate of parent, any proof attesting to the date of birth of parent/s) h) Step parents 60 years old and above • Marriage Certificate/Contract with registry number between biological parent of the member-child and the stepparent; • Birth Certificate of the stepparent (in its absence, a notarized affidavit of 2 disinterested persons attesting to the date of birth); • Birth Certificate of the member-child indicating the name of his/her biological parent; and • Death Certificate of member’s deceased biological parent
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Frontline Services & Clientele
Documentary Requirements
PhilHealth Forms
Fees/s
Duration
i) Adoptive parents 60 years old and above • Court Decree/Resolution of Adoption or photocopy of Birth Certificate o f the child in which the adoption is annotated thereto; and • Birth Certificate/s of adoptive parents or in its absence, a notarized affidavit of 2 disinterested Persons attesting to the date of birth j) Foster Child • Foster Placement Authority from DSWD Parents with permanent disability totally dependent with member • Original Medical Certificate issued by the attending physician within the past 6 months stating and describing the extent of disability 2.3 Sponsored Members (LGUs, etc.)
• MOA and OBR • Certified List/PMRF
• PMRF
• No service fee
•
10 minutes
For declaration of dependents • Same with requirements for declaration of new/additional dependents
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3. Payment of premium contributions (Formal / Informal Economy and Migrant Workers (land-based) Frontline Services & Clientele 3.1 Formal Economy (formerly known as Employed Segment)
Documentary Requirements
3.2.1 Informal Sector (formerly known as Individually Paying Member) 3.2.2 I-Group
Premium Contributions
For EPRS Users: •
EPRS generated Statement of Premium Accounts
For non-EPRS Users:
3.2 Informal Economy
PhilHealthForms
Duration
• 10 minutes •
PhilHealth Premium Payment Slip (PPPS)
PhilHealth Premium Payment Slip (PPPS)
• Refer to schedule of premium contributions in Annex 1
•
None
•
•
None
• PPPS
• Refer to schedule of premium contributions in Annex B, Table 2
•
Billing statement
• PPPS
• No service fee • Member need to pay per schedule as provided in Annex B, Table 2
• 5 minutes
• 10 minutes
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Frontline Services & Clientele 3.3 Sponsors (LGUs/Legislators)
3.4 Migrant Workers (land-based)
Documentary Requirements
• Billing statement
•
None
PhilHealthForms
Premium Contributions
Duration
• PPPS
• No service fee • Member need to pay per schedule as provided in Annex B, Table 2
• 10 minutes
• PPPS
• Refer to schedule of premium contributions in Annex B, Table 3
• 5 minutes
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4. Inquiry Frontline Services &
Documentary Requirements
PhilHealth Forms
Fees/s
Duration
Clientele 4.1
General Information - All
• Applicable forms such as PMRF, Claim Forms 1, 2 & 3, ER 1, 2 & 3, Premium Payment Slip • Info materials such as Pamphlets, brochures, flyers
•
None
•
Request Letter
Members
4.2
PhilHealth RefundAll Members
•
None
•
No service fee
•
8 minutes
•
No service fee
•
10 minutes
5. Updating of records Frontline Services & Clientele 5.1
All members
Documentary Requirements a) For correction of name • • If warranted, Birth certificate or 2 valid IDs with correct name or marriage certificate plus another valid ID with correct name / Affidavit of 2 disinterested persons b) For change of name (PC 50, s-2012) • If warranted, Annulment/Court Decision/Barangay Certificate/NSO with annotation/
PhilHealth Forms PMRF
Fee/s •
No service fee
Duration •
10 minutes
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Frontline Services & Clientele
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
c) Correction of date of birth • If warranted, Birth certificate or 2 valid IDs with correct date of birth or marriage certificate with correct date of birth plus another valid ID with correct date of birth d) Change of civil status • If warranted, Marriage Contract Certificate/Court Decision e) New and additional dependents • None • If warranted, Birth Certificate of the dependent/Court Decision on Adoption/Foster Parental Authority from DSWD/Medical Certificate for parents below 60 years old and children above 21 years old with permanent disability f) Change and correction of information of dependent/s •
Birth Certificate of the dependent/Court Decision on Adoption/Marriage Contract If warranted: Death Certificate of Spouse
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Frontline Services & Clientele 5.2
Documentary Requirements
Employers
5.2.1 Single Proprietorship
a) Correction/change of business name/legal personality • Certificate of Registration of Business Name from Department of Trade and Industry
PhilHealth Forms
• Employer Data Amendment Form (ER3)
Fee/s
•
No service fee
Duration
•
10 minutes
b) Temporary suspension of operation due to: • Bankruptcy Financial Statement; or Income Tax Return (ITR) • Fire / Demolition – Certification from the Fire Department of the locality; or Certification from the Municipal / City Hall • Separation of employee/s – Report on the Separation of the Last Employee/s; and Separation paper of the last employee/s • Termination / Dissolution For single proprietorship - approved application for Business Retirement by the Municipal/City Treasurer’s Office For partnership or corporation – Deed of Dissolution approved by SEC or minutes of the meeting certified by the Corporate Secretary For cooperatives – Certificate/Order of Dissolution/Cancellation issued by the CDA Under fortuitous events as defined by law – applicable supporting documents as may be determined by the Corporation 19 | P a g e
Frontline Services & Clientele
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
d) Change of ownership Deed of Sale / Transfer / Assignment signed by both parties* e) Resumption of Operation – Prescribed Philhealth Form reporting newly hired or re-hired employees • Death of managing owner (Family Business) – Death Certificate of the managing owner and waiver from the other legal heirs • Resumption of Operation Notice of Resumption of Operation from the employer, and List of Employees.
5.2.2 Partnership
a) Correction of business name • Certificate of Registration from Securities Exchange Commission; or Certificate of Articles of Partnership duly approved by Securities Exchange Commission
•
ER3
•
No service fee
•
10 minutes
b) Change of business name • Certificate of Amended Articles of Partnership duly approved by Securities Exchange Commission c) Change of legal personality (Partnership to Corporation) • Certificate of Articles of Incorporation duly approved by Securities Exchange Commission; and • Deed of Dissolution of Partnership approved by Securities Exchange Commission
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Frontline Services & Clientele
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
d) Temporary suspension of operation due to: • Bankruptcy – Financial Statement; or Income Tax Return (ITR) for the year showing non-operation/no earnings • Fire/Demolition/Flood – Certification from the Fire Department of the locality; or Certification from the Municipal/City Hall • Strike – Notice of Strike duly licensed by DOLE • Separation of employee/s Report on the Separation of the Last Employee/s; and Separation paper of the last employee/s
e) Termination/Dissolution • Deed of Dissolution of Partnership approved by Securities Exchange Commission (SEC); and • Minutes of the Board Meeting duly certified by the Corporate Secretary
f) Merger/Consolidation • Deed of Merger/Merger Agreement duly approved by SEC; or • Memorandum of Agreement filed with SEC
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Frontline Services & Clientele
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
g) Change of Ownership • Sale – Deed of Sale/Transfer/Assignment signed by both parties License to Operate (LTO) reflecting the name of the owner • Death of managing owner (Family Business) – Death Certificate of the managing owner and waiver from the other legal heirs h) Resumption of Operation • Notice of Resumption of Operation from the employer, and • List of employees.
5.2.3 Corporation
a) Correction of business name • Certificate of Registration from SEC; or • Certificate of Articles of Partnership duly approved by SEC
•
ER3
•
No service fee
•
10 minutes
b) Change of business name • Certificate of Amended Articles of Incorporation duly approved by SEC c) Change of legal personality (Corporation to Partnership) • Certificate of Articles of Partnership duly approved by SEC; and • Deed of Dissolution as Corporation approved by SEC 22 | P a g e
Frontline Services & Clientele
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
d) Temporary suspension of operation due to: • Bankruptcy – Financial Statement; or Income Tax Return (ITR) for the year showing non-operation/no earnings; or Board Resolution certified by the Corporate Secretary • Fire/Demolition/Flood Certification from the Fire Department of the locality; or Certification from the Municipal/City Hall • Strike – Notice of Strike duly licensed by DOLE • Separation of employee/s – Report on the Separation of the Last Employee/s; and Separation paper of the last employee/s
e) Termination/Dissolution • Deed of Dissolution approved by Securities Exchange Commission; and • Minutes of the Board Meeting duly certified by the Corporate Secretary f) Merger/Consolidation • Deed of Merger/Merger Agreement duly approved by SEC; or • Memorandum of Agreement filed with SEC
23 | P a g e
Frontline Services & Clientele
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
g) Change of ownership • Sale – Deed of Sale/Transfer/Assignment signed by both parties License to Operate (LTO) reflecting the name of Owner • Death of managing owner (Family Business) – Death Certificate of the managing owner and waiver from the other legal heirs
h) Resumption of Operation • Notice of Resumption of Operation from the employer, and • List of employees 5.2.4 Cooperative
a) Correction of business name • Certificate of Registration from Cooperative Development Authority (CDA); or • Certificate of Articles of Cooperation duly approved by CDA
•
ER3
•
No service fee
•
10 minutes
b) Change of business name • Certificate of Amended Articles of Cooperation duly approved by CDA
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Frontline Services & Clientele
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
c) Temporary suspension of operation due to: • Bankruptcy – Financial Statement; or Income Tax Return (ITR) for the year showing non-operation/no earnings; • Fire/Demolition/Flood – Certification from the Fire Department of the locality; or Certification from the Municipal/City Hall • Separation of employee/s – Report on the Separation of the Last Employee/s; and Separation paper of the last employee/s
d) Termination/Dissolution • Dissolution of Cooperation duly approved by CDA
e) Resumption of operation • Notice of Resumption of Operation from the employer, and • List of employees
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6.
Submission of application for accreditation Frontline Services &
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele 6.1 Health Care Institutions (HCIs)
6.1.1 General requirements
1. 2.
3.
4.
5.
6.1.2 Specific requirements (to be submitted in addition to the general requirements
Properly accomplished Provider Data Record (PDR) Duly signed and properly filled out Performance Commitment (PC) applicable for single HCI or group of HCIs
•
•
Provider profile Record (properly accomplished) Performance Commitment
•
Refer to schedule of accreditation fees of HCI – Annex C
•
30 minutes
Electronic copies of recent photos (JPEG format) of the following required areas of the facility, taken within three months, to be submitted in CD or USB: a. Internal area - PhilHealth ward, ER, OR, RR, DR, ICU, if applicable) b. External – facade of the facility Statement of Intent (SOI). if applicable For hospitals and outpatient package providers applying for initial/re-accreditation from October to December of the current year on the validity of accreditation Latest audited financial statement/report (refer to A.1.a of PC 31, s2012) reflecting the income/payments received from PhilHealth (not required for Initial accreditation)
26 | P a g e
Frontline Services &
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele
1. Hospitals
1.
DOH license with validity applicable to the accreditation period applied for 2. Certificate of Accreditation issued by an ISQUAaccredited organization, if applicable 3. DOH licenses from 3 previous years or any of the following alternative document (only for initial accreditation): a. Supporting documents showing the Managing Health Care Professional’s(HC Professional) Education and Work experience such as: i. Certificate of completion of a masteral degree in hospital administration or other related degree; or ii. Any of the following proof of the work experience of the Managing HC Professional for three (3) years in a similar or analogous or at least the same level of accredited institution /facility it is applying for such as: • Service record from accredited government facility, or • Certification from the Board of the Corporation or Foundation, or • Certification from the Facility Owner of the private facility, or b. DOH LTO as Level 2 or 3 hospital ; or c. Certification from the LGU (signed by the LCE) that the LGU where the HCI operates cannot adequately or fully service its population; or d. Any proof that the HCI is an extension or branch of a HCI that has been accredited for at least 2 years such as: i. Securities & Exchange Commission (SEC) 27 | P a g e
Frontline Services &
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele
Registration, including Articles of incorporation ii. Deed of Sale iii. Cooperative Development Authority (CDA) certificate iv. Dept of Trade Industry certificate (For private HCIs) 2. Ambulatory Surgical Clinic (ASC), Freestanding Dialysis Clinic (FSDC) and Primary Care Facility
1.
3. Primary Care Benefit Provider
1. Performance Commitment with specific provision for PCB 2. MOA with referral secondary laboratory for providers with no capability to provide lipid profile and FBS (sSigned by representative/s of the applicant HCI and referral facility ; name of the HCI and HCI representatives are reflected in the MOA; signatories in the MOA are also the signatories in the Performance Commitment): 3. Location map
4. Out-patient Malaria Package Provider
1. Certificate of Training in Malaria issued by DOH/CHDs 2. Any of the following proof that the staff is an employee of the applicant HCI, e.g. most recent payroll with the name of the staff in it or remittance form 1 or contract of service/service record
2.
DOH license with validity applicable to the accreditation period applied for DOH licenses from 3 previous years or its required alternative document for initial engagement of private clinics (same requirement as #3 of 1.1.2.1 above)
28 | P a g e
Frontline Services &
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele
5. Maternity Care Package Provider
1. Certificate of Compliance as a BEmONC facility (for automatic accreditation) 2. Certificate as Newborn Screening Facility or letter of approval as a Newborn screening facility (NSF) issued by the CHD or Newborn Screening Reference Center (NSRC) 3. Any of the following for applicable referral system: MOA or Proof of Affiliation of the physician with at least a Level 1 PhilHealth accredited hospital MOA with referral physician/s for OB and Pedia cases as applicable MOA with a DOH-certified BEmONC - CEmONC network (if not BEmONC Certified) 4. Location map 5. Business Permit (for private facilities) 6. If the HCI will perform IUD insertion in the facility, submit the Certificate on “ Family Planning Competency Based Training ( FPCBT) Level 2 of the accredited Physician or Midwife who performs the IUD insertion, or Residency Training certificate on Obstetrics and Gynecology of the accredited physician
6. TB DOTS Package Providers
1. Updated DOH - PhilCAT Certificate 2. Location map
7. Animal Bite Treatment Package Provider
1. Certification as an Animal Bite Treatment Center (ABTC/ABC) from the DOH - National Rabies Prevention and Control Program Office 2. Location map 29 | P a g e
Frontline Services &
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele
6.2 Health Care Professional (HC Professionals) 6.2.1 General 1. Properly accomplished PhilHealth application form 2. Duly notarized Warranties of Accreditation 3. 1 x 1 ID picture (2pcs) 4. PRC license, PRC claim stub or certification from PRC – updated 5. Proof of payment of required premium contributions (MI5 or Official Receipt or Certification from PhilHealth of Paid Premium Contributions or RF1 for the employed)
•
•
Application form for Accreditation of Health Care Professionals Warranties of Accreditation
•
30 minutes
6.2.1 Specific requirements (to be submitted by PHCP in addition to the general requirements) 1. Physicians i) General Practitioner
ii)
General Practitioner (with training)
Initial accreditation • TIN Card/BIR Form 2316 or certification issued by BIR indicating TIN Initial accreditation or re-accreditation due to upgrading/downgrading • TIN Card/BIR Form 2316 or certification issued by BIR indicating TIN – for initial accreditation only • Proof of completed residency training (local or abroad)
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Frontline Services &
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele iii) Medical Specialist
2. Dentist
3. Midwife
Initial accreditation or re-accreditation due to upgrading • TIN Card/BIR Form 2316 or certification issued by BIR indicating TIN – for initial accreditation only • Philippine Specialty Board certificate Initial accreditation • TIN Card/BIR Form 2316 or certification issued by BIR indicating TIN Initial accreditation •
TIN Card/BIR Form 2316 or certification issued by BIR indicating TIN • Any of the following evidences of Competency on the Expanded Functions of Midwives (not required for graduates from school year 1995 and onwards): Certificate of Training from a program accredited by the Continuing Professional Education (CPE), Council of the Board of Midwifery of the Professional Regulation Commission (PRC); or
Training Certificate from DOH-recognized training program; or Certificate of Apprenticeship for one or more years with a PHIC accredited ObstetricianGynecologist/OB DOH Specialist or an accredited midwife done in an accredited facility
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Frontline Services &
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele
For appreciation of witholding tax (not a pre-requisite for accreditation) • Certificate of Registration (for initial accreditation only) • Affidavit/Sworn Declaration of Current Year’s Gross Income (stamped received by BIR and shall be submitted every June 30 to July 22 of each year)
7. 1 Filing of Claims under Fee-For-Service and Case Rate (PhilHealth Circular No. 11, 11A and 11B, s.2011) Frontline Services & Clientele 7.1.1 Member (Direct filing)
Documentary Requirements • •
• • • • •
Hospital and doctor’s waiver and original official receipts of full payment Original official receipts or photocopies of the same authenticated by PHIC staff (with original copies seen) for medicines bought outside the hospital or laboratory tests performed outside the hospital during confinement The authenticated photocopies is applicable in cases where original ORs are required by and submitted to HMOs Operative Record (if surgery was performed) Hospital Statement of Account duly signed by the hospital clerk or representative of the patient For Informal Economy members, latest Proof of Payment. For Indigents, Sponsored or Lifetime members, clear copy of PhilHealth ID Anesthesia and Surgical or Operative Record (if surgery
PhilHealth Forms •
•
Claim Form 1 Claim Form 2 Claim Form 3/ Clinical Abstract (if necessary) (also mandatory for case payment) Member Data Record
•
Fee/s
Duration
No service fee
10 minutes per claim
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Frontline Services & Clientele
Documentary Requirements
• •
7. 1.2 HCP
PhilHealth Forms
Fee/s
Duration
was performed). Medical Certificate or Clinical Abstract indicating final diagnosis of patient, confinement period and services rendered written in English (if confined abroad) Additional requirements for confinements in nonaccredited health care institutions: Health Care Institution’s DOH License Clinical Abstract or CF3 indicating case was emergency and justification for impossibility of transferring patient to accredited health care institution.
Attached to claim • Operative Record with surgical technique (if surgery was performed) • Statement of Account (mandatory for fee-for-service only) • Original Official Receipts of medicines bought outside the hospital and x-ray/laboratory test performed outside the hospital during confinement* *X-ray/Laboratory results – mandatory for case payment From member • For Informal Economy members, latest Proof of Payment. • For Indigents, Sponsored or Lifetime members, clear copy of PhilHealth ID • Original Official Receipts of medicines bought outside the hospital or laboratory tests performed outside the hospital during confinement (if applicable)
• •
Claim Form 2 Claim Form 3 or Clinical Abstract (if required by policy)
30 minutes (for every 100 claims)
From member •
Claim Form 1
•
Member Data Record
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7.2 Filing of All Case Rate Claims (PhilHealth Circular No. 35, s.2013) Frontline Services & Clientele 7.2.1 Member (Direct filing)
Documentary Requirements • •
• • • • •
•
Hospital and doctor’s waiver and original official receipts of full payment Original official receipts or photocopies of the same authenticated by PHIC staff (with original copies seen) for medicines bought outside the hospital or laboratory tests performed outside the hospital during confinement The authenticated photocopies is applicable in cases where original ORs are required by and submitted to HMOs Hospital Statement of Account duly signed by the hospital clerk For Informal Economy members, latest Proof of Payment. For Indigents, Sponsored or Lifetime members, clear copy of PhilHealth ID Anesthesia and Surgical or Operative Record (if surgery was performed). For certain procedure listed in Annex No. 10 of PhilHealth Circular No. 35, s.2013, Doctor’s order, Nurse’s notes or official results shall be required. For confinements abroad: Certification from the attending physician as to the final diagnosis, period of confinement and services rendered with English translations from hospital or Embassy for all documents.
PhilHealth Forms •
Claim Form 1 (this shall be the only form required for confinements abroad) Claim Form 2 Claim Form 3/Clinical Abstract (if necessary) Member Data Record, PhilHealth Benefit Eligibility Form or PhilHealth Cares Form 1.
•
Fee/s
Duration
No service fee
10 minutes per claim
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Frontline Services & Clientele
7.2.2
Health Care Institution Filed Claims
Documentary Requirements any proof of payment of hospital bills and professional fees from the HCI where the patient was confined. • Additional requirements for confinements in nonaccredited health care institutions: Health Care Institution’s DOH License Clinical Abstract or CF3 indicating case was emergency and justification for impossibility of transferring patient to accredited health care institution. Attached to claim • Operative Record with surgical technique (if surgery was performed). •
Original Official Receipts of medicines bought outside the hospital and x-ray/laboratory test performed outside the hospital during confinement.
•
Claims for TB DOTS Package shall have a copy of NTP Treatment Card in lieu of Claim Form 3.
•
For Animal Bite Treatment Package, providers may use Claims Summary Form attached as Annex B of PC 15, s 2012 instead of Claim Form 2. Moreover, submission of Claim Form 3 is not required.
•
Claims for Newborn Care Package shall have a copy of certificate of live birth. A copy from the facility without the registry number is acceptable as long as the records officer/clinic administrator of that facility certifies that it is the same copy which will be submitted for
PhilHealth Forms
• •
Claim Form 2 Claim Form 3 for Maternity Care Package and Primary Care Facilities
Fee/s
Duration
No service fee
30 minutes (for every 100 claims)
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Frontline Services & Clientele
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
registration to local civil registrar. The Claim Form 2 shall have an attached filter collection card number of the NBS specimen. Also, Claim Form 3 is not required From member
• • •
Latest Proof of Payment (for Informal Economy members) Clear copy of PhilHealth ID (for Indigents, Sponsored or Lifetime members) Original Official Receipts of medicines bought outside the hospital or laboratory tests performed outside the hospital during confinement (if applicable)
From member
• •
Claim Form 1 Member Data Record
8. Submission of reports (manual) Frontline Services &
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele 8.1 Employer (For non-EPRS employers only) 8.1.1 Hard copy RF1 users (employers with 10 and below employees)
• Employers Remittance Report (RF1) • PAR or POR • Bills Payments (from accredited collecting agents)
• RF1
• No service fee
• 10 minutes
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Frontline Services &
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele 8.1.2 Soft copy RF1 users (employers with 11 and above employees)
• Textfile or MS Excel format Textfile • PAR or POR • Bills Payments (from accredited collecting agents)
• None
• No service fee
• 20 minutes
9. Request for records Frontline Services &
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele 9.2 Employers
If through representative •
Authorization letter from the employer
•
Any valid ID of the representative
•
Request Form
•
No service fee
• 15 minutes
10. Check releasing Frontline Services &
Documentary Requirements
PhilHealth Forms
Fee/s
Duration
Clientele 10.1 All Members
•
10.2 Stakeholders
•
•
Photocopy of 2 valid IDs of the Member For authorized representative, authorization letter, photocopy of 2 valid IDs of the member and 2 valid IDs of the representative and/or SPA
•
None
•
No service fee
•
15 minutes
Valid identification of the authorized representative
•
None
•
No service fee
•
30 minutes
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F. Matrix of service standards (for frontline services) 1. Membership Registration 1.1 Employer Client Step
PhilHealth Action
Office/Person Responsible
Duration*
1. Secure information, membership registration form (ER1) and number at the Public Assistance Desk or Special Lane Section for PWDs/pregnant women. 2. Submit duly accomplished Employer Data Record (ER1 Form) and supporting documents once the number is called
1. Receive and screen duly accomplished ER1 Form together with supporting documents 2. Encode to MCIS 3. Print the Employer Data Record and Certificate of Registration 4. Release the Employer Data Record and Certificate of Registration
• Frontline Officer
• 20 minutes
3. Receive the Employer Data Record and Certificate of Registration
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1.2.
Employees (Employed Sector)
Client Step 1. Secure information and/or number at the Public Assistance Desk or Special Lane Section for PWDs/pregnant women.
PhilHealth Action
Office/Person Responsible
2. Submit duly accomplished PMRF together with the Report of Employee-Members (Er2) and supporting documents once the number is called
1. Receive and screen duly accomplished PMRF, Er2 and supporting documents 2. Reconcile the name/s of the employees indicated in the Er2 form against the attached PMRF 3. Return received copy of Er2 (if submitted PMRFs are more than 5) or advise the client to wait for the release of PhilHealth Number Card (PNC) and Member Data Record (MDR) if submitted PMRFs are 5 and below at the Releasing Counter
• Frontline Officer
3. Receive advice and received copy of ER2 4. Endorse PMRFs to Support Officer for from the Frontline Officer if documents processing submitted are to be mailed or proceed to 5. Process PMRFs the Releasing Counter once the name of the Detailed Processing: company/business is called. 5.1 Verify if name of employee already exists in the system 5.2 Encode data indicated in the PMRF in the system 5.3 Print PhilHealth Number Cards (PNC) and Member Data Record (MDR) 6. Release the Philhealth Number Card/s (PNC) and Member Data Record/s (MDR)
• Frontline Officer
Duration
• 25 minutes (for 5 PMRFs and below) • 10 working days for 6 PMRFs and above
• Support Officer
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Client Step 4. Receive copy of PNC and MDR at the Releasing Counter
PhilHealth Action
Office/Person Responsible
Duration
PhilHealth Action
Office/Person Responsible
Duration
1.3 Lifetime Members Client Step 1. Secure information, PhilHealth Member Registration Form (PMRF) and number at the Special Lane Section. 2. Submit duly accomplished PMRF and supporting document, if applicable, once the number is called.
1. Receive and screen duly accomplished PMRF with supporting documents
•
Frontline Officer
•
30 minutes
2. Encode/assign/update member data and scan signature of member 3. Print the Member Data Record (MDR) and Identification Card
3. Sign name in the PhilHealth ID card
4. Laminate the printed Identification Card with the ID picture of the Client/Member 5. Release the laminated Identification Card to Client/Member together with the Member Data Record (MDR) and have the member sign/acknowledge receipt of documents
4. Receive the Identification Card and Member Data Record (MDR) and acknowledge receipt
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2. Membership Enrollment 2.1 Informal Sector formerly known as Individually Paying Members ClientStep PhilHealth Action
Office/Person Responsible
Duration
1. Secure information, PhilHealth Member Registration Form (PMRF) and number at the Public Assistance Desk or Special Lane Section for PWDs/pregnant women. 2. Submit duly accomplished PMRF and supporting documents and payment slip once the number is called.
1. Receive and screen duly accomplished PMRF with supporting documents
•
Frontline Officer
•
10 minutes
•
Payment processor/Collecting Officer
•
5 minutes
•
Collecting Officer
•
5 minutes
2. Evaluate the completeness of data in the PMRF 3. Encode/assign/update in the MCIS 4. Print the Member data Record (MDR) and PhilHealth Identification Card (PNC) of the Client/Member 5. Endorse payment slip to the assigned payment processor and advise to proceed to the Payment Processor window and return after payment has been made
3. Proceed to the Cashier’s window once number is called, tender payment (premium contribution) and receive Official Receipt
6. Encode payment slip and assign number
4. Proceed to Frontline Officer and receive PNC and MDR
8. Receive payment from client, print Official Receipt (OR) and issue OR
7. Advise member to proceed to Cashier’s Window once the number is called
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2.2 Migrant Workers (Land-based) Client Step 1. Secure information, PhilHealth Member Registration Form (PMRF) and number at the Public Assistance Desk or Special Lane Section for PWDs/pregnant women. 2. Submit duly accomplished PMRF and payment slip once the number is called.
PhilHealth Action
Office/Person Responsible
Duration*
1. Receive and screen duly accomplished PMRF with supporting documents and payment slip 2. Encode/assign/update member’s data 3. Endorse payment slip to the assigned Payment Processor/Collecting Officer and advise client to proceed to the Payment Processor window and return after payment has been made
•
Frontline Officer
•
10 minutes
3. Proceed to the Payment Processor desk and receive priority number
4. Encode payment slip and assign number 5. Advise member to proceed to Cashier’s Window once the number is called
•
Payment Processor/ Collecting Officer
•
5 minutes
4. Proceed to the Cashier’s window once number is called, tender payment (premium contribution) and receive Official Receipt
6. Receive payment, issue OR and advice client/member to proceed to Frontline Officer to get PhilHealth Number Card (PNC) / Member Data Record (MDR)
•
Collecting Officer
•
5 minutes
7. Print and release MDR and PNC
•
Frontline Officer
5. Receive PNC and MDR from Frontline Officer
42 | P a g e
3. Updating of membership records
Client Step 1. Secure information, PhilHealth Member Registration Form (PMRF) and number at the Public Assistance Desk • Special Lane for PWDs, Pregnant Women and Senior Citizens 2. Submit duly accomplished PhilHealth Member Registration Form (PMRF)/ER3 and supporting documents once number is called
PhilHealthAction
1. Receive and screen duly accomplished PMRF with supporting documents 2. Encode/update Client/Member’s data 3. Print amended Member Data Record (MDR)/ PhilHealth Identification Card (PIC- if applicable) 4. Release amended MDR/PIC (if applicable) to the member or Employer Data Record (EDR) to the employer
Office/PersonResponsible
• Frontline Officer
Duration*
• 15 minutes per PMRF
3. Receive updated MDR/PIC (if applicable)/EDR *Under normal circumstances per transaction
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4. Request for records (MDR, Certificates, PIC, CE1)
Client Step
PhilHealth Action
Office/Person Responsible
Duration*
1. Secure information, number and request for documents form at the Public Assistance Desk 2. Submit duly accomplished request for documents form (with supporting documents if applicable) once number is called
1. Receive properly filled up request form w ith supporting documents (if applicable) 2. Process request of client 3. Release requested documents and require member to acknowledge receipt of documents
• Frontline Officer
• 15 minutes per requested form/ document
3. Receive requested document and acknowledge receipt *Under normal circumstances per transaction
44 | P a g e
5. Payment of premium contributions
Client Step 1. Secure PPPS at the Public Assistance Desk and secure number if applicable
PhilHealth Action
Person Responsible
Duration*
2. Fill out PPPS 3. Submit payment slip to the Payment Processor
1. Receive and encode payment slip, assign number if applicable and advise Client/Member to proceed to the cashier’s counter once number is called
• Payment Processor
4. Proceed to Cashier's window and tender payment once priority number is called
2. Receive money from the Client/Member and print Official Receipt(OR) 3. Release/issue PhilHealth Official Receipt Note: LHIOs may combine all PhilHealth actions
• Collecting Officer
• 10 minutes
5. Receive PhilHealth Official Receipt *Under normal circumstances per transaction
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6.
Inquiry/public assistance
Client Step • Proceed to the Public Assistance Desk/Corner and ask for information.
7.
•
•
•
•
PhilHealth Action • Accommodate client’s inquiry
Office/Person Responsible • Frontline Officer
Duration • 8 minutes
Office/Person Responsible • Public Assistance Staff
Duration * 1 minute
Filing of claims by Health Care Institutions (HCI) Client Step Secure information and/or priority number at the Public Assistance Desk When priority number is called, proceed to Frontline Service Counter and submit claims together with the transmittal list Affix initials to copy of transmittal list, if with correction.
Receive copy of acknowledged transmittal list
• • •
•
•
PhilHealth Action Direct client/s to the appropriate front line service. Provide the priority number to client/s. Receive and screen claims as to the correct number and names of claimants against transmittal list.
•
Frontline Officer
•
•
30 minutes for every 100 claims
Stamp “received” on the transmittal list if there are no deficiencies in the transmittal and total number of claim; if there is/are name/s listed but no claims attached, cross-out name/s in the list and have the transmittal list initialed by the hospital representative/health care provider. Return received copy of transmittal list to hospital representative/health care provider and advise client that processing of claims will be done within the 60-day period
*Under normal circumstances per transaction
46 | P a g e
•
•
•
•
Filing of claims (Direct-filing by members) Client Step Secure information and/or priority number at the Public Assistance Desk When priority number is called, submit duly accomplished acknowledgement receipt form, PhilHealth claims with supporting documents once priority number is called Receive acknowledgement receipt or claim with deficiency
• • • •
•
PhilHealth Action Office/Person Responsible Direct client/s to the appropriate front line • Public Assistance Staff service. Provide the priority number to client/s. Receive and screen claims as to completeness • Frontline Officer of documentary requirements (non-medical). Stamp “received” the acknowledgement receipt form and return copy to client/member or return acknowledgement receipt and PhilHealth claim if with deficiency for client/member’s compliance. Advise Client/Member to expect notice/Benefit Payment Notice (BPN) (within the 60-day period) or to comply with the required/deficient documents/information.
•
Duration * 1 minute
•
10 minutes
*Under normal circumstances per transaction
47 | P a g e
9.
Submission of remittance reports (RF1)
Client Step 1. Secure information and/or number if applicable a the Public Assistance Desk
PhilHealth Action
2. Submit remittance report (RF-1) and/or diskette/flashdrive once number is called
1. Receive and screen remittance report (as to number and/or data stored in the diskette/flash drive). 2. Stamp “received” on the remittance report 3. Return received copy of remittance report/flash drive to client.
Office/Person Responsible
• Frontline Officer
Duration*
• 20 minutes (every 50 pages) • 30 minutes (soft copy)
3. Receive copy of acknowledged remittance report *Under normal circumstances per transaction
10. Submission of application for accreditation of Health Care Institution (HCI) Client Step PhilHealth Action 1. Secure priority number and information and payment slip at the Public Assistance Desk 2. Submit duly accomplished 1. Receive Provider Data Record (PDR), other application forms for accreditation accreditation documentary requirements and and supporting documents together payment slip (order of payment) with the properly-filled -out 1. Screen application and other documentary payment slip once priority number is requirements as to completeness of called requirements 2. Write down the HCI data in the receiving logbook
Office/Person Responsible
•
Frontline Officer
Duration*
4. 30 minutes
48 | P a g e
Client Step 3. If the application is not complete, get the receiving copy of the application, receive deficiency letter and explanation on the content of the letter and sign under “disposition” column in the receiving logbook
4. Proceed to Cashier 5. Proceed to frontline service counter and get receiving copy of the PDR and other requirements.
PhilHealth Action 3.
Office/Person Responsible
Duration*
If the application is not complete, return the application to the HCI, furnish a Deficiency Letter, explain the content of the deficiency letter and ask HCI representative to sign under “disposition” column in the receiving logbook
5. If the application is complete, stamp complete
the file copy and the receiving copy (PDR and the 1st page of the other requirements) 6. Endorse payment slip (order of payment) to client and advice to proceed to the Payment Processor window and return after payment has been made. 7. Receive payment for accreditation of the HCI, print and release Official Receipt 8. Release the receiving copy of the PDR and other
requirements to the HCI representative 9. If LHIO has an integrated PhilHealth Accreditation System ( iPAS) , they will encode the following HCI data in the receiving module of IPAS a. Name of HCI b. Address c. Date of submission d. OR number e. Amount of payment f. Date of Payment g. Manner of submission h. Documents submitted
•
Collecting Officer
•
Frontline Officer
*Under normal circumstances per transaction 49 | P a g e
11. Submission of application for accreditation Health Care Professionals (HC Professional) Client Step 1. Secure priority number and information and payment slip at the Public Assistance Desk 2. Submit duly accomplished application form for accreditation and supporting documents
PhilHealth Action
1. 2. 3.
3. If the application is not complete, get the application and all other requirements, receive the deficiency letter and sign under “disposition” column in the receiving logbook
4.
4. If the application is complete, get the receiving copy of all the requirements and receipt of payment.
5.
6. 7.
Receive application for accreditation, and other supporting documents Screen as to completeness of requirements Write down the HC Professional data in the recceiving logbook If the application is not complete, return the application to the HCI, furnish Deficiency Letter, explain content of deficiency letter and ask HCI representative to sign under “disposition” column in the receiving logbook
Office/Person Responsible
•
Frontline Officer
Duration*
30 minutes
If the application is complete, stamp complete the file copy and receiving copy of the application and the 1st page of the other requirements. Release receiving copy of the application to the HCI applicant If LHIO has iPAS, encode the following HCI data in the receiving module of IPAS a. Name of HC Professional b. Address c. Date of submission d. Manner of submission e. Documents submitted
*Under normal circumstances per transaction
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12. Check releasing (pick-up by member) Client Step 1. Secure priority number at the Public Assistance Desk if applicable 2. Present valid IDs once number is called at the Check Releasing Counter/Cashier’s window
PhilHealth Action
1. Verify if claim check is available, if not, advice client/member of status of the check( if not yet available etc.) 2. Validate IDs presented if check is available and Release to client/member. 3. Require member to acknowledge receipt of the check thru the logbook.
Office/Person Responsible
• Frontline Officer
Duration*
• 15 minutes
3. Acknowledge receipt of check. *Under normal circumstances per transaction 13. Check releasing (pick-up by stakeholders)
Client Step 1. Secure number at the Public Assistance Desk if applicable
PhilHealth Action
2. Present valid company IDs once 1. Receive and validate company ID priority number is called at the Check Releasing Counter/Cashier’s window 3. Countercheck/validate cheques received then acknowledge receipt of check, affix signature in the logbook and disbursement voucher
Office/Person Responsible
• Frontline Officer
Duration*
• 30 minutes
2. Verify if check is available, if not, advice client of status of the check, if check is available release check to client. 51 | P a g e
Client Step
PhilHealth Action
Office/Person Responsible
Duration*
3. Require client to acknowledge receipt of the check thru the logbook and disbursement voucher. 4. Issue official receipt 4. Receive the official receipt and file *Under normal circumstances per transaction
14. Request for other services
Client Step PhilHealth Action Office/Person Responsible Duration* Other services include: (a) Replacement of check; (b) Adjustment of benefit payment; (c) Adjustment of premium contribution; (d) Filing of complaints against health providers/professionals; and (e) Walk-inquiries 1. Secure priority number, information and applicable forms at the Public Assistance Desk 2. Submit duly accomplished forms and supporting documents (if applicable) once priority number is called 1. Receive request form/applicable forms 2. Check/Evaluate documents received. 3. Provide feedback on requested service; advise member/stakeholder appropriately 4. Ask member/stakeholder to affix signature in logbook to acknowledge filing of request
• Frontline Officer
15 minutes per transaction
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Client Step 3. Acknowledge receipt of document requested and/or advice and affix signature in the logbook
PhilHealth Action
Office/Person Responsible
Duration*
*Under normal circumstances per transaction
15. Feedback mechanism
Client Step 1. Proceed to the LHIO Head
PhilHealth Action 1. Accommodate/handle client’s concern/s 2. Provide feedback and/or resolve the client’s concern 3. Advise/Assist client to fill up feedback form (if necessary) 4. Politely close the conversation 5. Record the transaction
2. Fill out feedback form
6. Retrieve the feedback form in the feedback box daily and record and resolve the issues in the feedback form 7. Refer to the appropriate office
3. Awaiting feedback
8. Provide feedback if necessary
Office/Person Responsible • Local Health Insurance Office (LHIO) Head
Duration* • 20 minutes
Daily
Concerned Office
Within 10 calendar days upon receipt
``
53 | P a g e
G. Process Flow Chart
54 | P a g e
H. Feedback and Redress Mechanism
PhilHealth provides a Feedback/ Suggestion Box to its Local Health Insurance Offices wherein clients may drop the accomplished Client Feedback Form available thereat. The said box will be opened and checked daily for content(s), if any. You can also visit our website, www.philhealth.gov.ph to download
forms
or
our
social
media
accounts,
www.facebook.com/PhilHealth
Thank you.
Client Feedback Form
and
www.twitter.com/teamphilhealth for online feedback.
You can also talk anytime to our Officer-of-the-Day for assistance regarding our Client Feedback Form. We value your feedback for better service. Name: All feedback will be promptly acknowledged and any complaint/ grievance that requires action will be undertaken
Address:
and communicated within 30 working days from receipt of the same.
Phone Number: Email CityState Centre Bldg.,
Your Satisfaction is our Fulfillment
709 Shaw Blvd., Brgy. Oranbo, Pasig City Phone: 02-4417442
Address: Office Address:
Email:
[email protected]
55 | P a g e
E. F. G.
Client Feedback Form
Service being complained:
Please check the appropriate box.
Suggestions to improve our service:
Are you satisfied with our service? Yes
No Office:
Reason: Name/Position of staff who rendered service:
When did it happen? Commendation for services or staff Complaint about our services or staff
Facts of complaint:
Please use additional sheet if necessary
Suggestions to improve our services Service/employee being commended: What is your desired action from our office? Office/Position:
Name: Signature:
Reason for commendation: Date:
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I. Anti-Fixer Campaign Banner
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J. Anti-Fixer Calling Card 3.5 inches
2 inches
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Annex A Table 1. Premium Contribution Table for the Formal Economy including sea-based employees and Kasambahay (January to December 2014 only per PC 57, s2012) Salary
Salary Range
Salary Base
1
8,999.99 and below
8,000.00
2
9,000.00-9,999.99
3
Total Monthly
Employee Share*
Employer Share
200.00
100.00
100.00
9,000.00
225.00
112.50
112.50
10,000.00-10,999.99
10,000.00
250.00
125.00
125.00
4
11,000.00-11,999.99
11,000.00
275.00
137.50
137.50
5
12,000.00-12,999.99
12,000.00
300.00
150.00
150.00
6
13,000.00-13,999.99
13,000.00
325.00
162.50
162.50
7
14,000.00-14,999.99
14,000.00
350.00
175.00
175.00
8
15,000.00-15,999.99
15,000.00
375.00
187.50
187.50
9
16,000.00-16,999.99
16,000.00
400.00
200.00
200.00
10
17,000.00-17,999.99
17,000.00
425.00
212.50
212.50
11
18,000.00-18,999.99
18,000.00
450.00
225.00
225.00
12
19,000.00-19,999.99
19,000.00
475.00
237.50
237.50
13
20,000.00-20,999.99
20,000.00
500.00
250.00
250.00
14
21,000.00-21,999.99
21,000.00
525.00
262.50
262.50
15
22,000.00-22,999.99
22,000.00
550.00
275.00
275.00
16
23,000.00-23,999.99
23,000.00
575.00
287.50
287.50
17
24,000.00-24,999.99
24,000.00
600.00
300.00
300.00
18
25,000.00-25,999.99
25,000.00
625.00
312.50
312.50
19
26,000.00-26,999.99
26,000.00
650.00
325.00
325.00
Bracket
Premium
59 | P a g e
Salary
Salary Range
Salary Base
20
27,000.00-27,999.99
27,000.00
21
28,000.00-28,999.99
22
Total Monthly
Employee Share*
Employer Share
675.00
337.50
337.50
28,000.00
700.00
350.00
350.00
29,000.00-29,999.99
29,000.00
725.00
362.50
362.50
23
30,000.00-30,999.99
30,000.00
750.00
375.00
375.00
24
31,000.00-31,999.99
31,000.00
775.00
387.50
387.50
25
32,000.00-32,999.99
32,000.00
800.00
400.00
400.00
26
33,000.00-33,999.99
33,000.00
825.00
412.50
412.50
27
34,000.00-34,999.99
34,000.00
850.00
425.00
425.00
28
35,000.00 and up
35,000.00
875.00
437.50
437.50
Bracket
Premium
*Employee share represents half of the total monthly premium while the other half is shouldered by the employer.
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Annex B
Table 2. Premium Contribution Table for the Informal Economy /Sponsored Members Self Earning Individuals
3,600/annum
Informal members with income P25,000 and below
2,400/annum
Sponsored Members
2,400/annum
Table 3. Premium Contribution Table for Migrant Workers Land-based
2,400/annum
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Table 4. Schedule of Accreditation Fee for Health Care Institutions INSTITUTIONS
INITIAL, CONTINUOUS/ RE-ACCREDITATION (PRIVATE/GOVERNMENT)
Level III Hospitals (teaching Hospitals)
P 10,000.00
Level II Hospitals
P 8,000.00
Level I Hospitals
P 5,000.00
Primary Care Facility (Infirmary/Dispensary) Specialty Hospital
P 3,000 Based on the service Capability of the hospital
Ambulatory Surgical Centers (ASCs)
P 5,000.00
Free Standing Dialysis Centers (FDCs)- HD and PD
P 5,000.00
Primary Care Benefit Providers (PCB)
P 1,000.00
TB-DOTS Provider
P 1,000.00
Non-Hospital Maternity Care Providers
P 1,500.00
PCB (OPB) and DOTS Providers
P 1,000.00
PCB (OPB) and MCP Providers
P 1,500.00
PCB, DOTS and MCP Providers MCP and DOTS Providers Animal Bite Package Providers
Annex C
P 1,500 P 1,500.00 P 1,000
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